To PSA or not to PSA? How to Check Prostate Health

For many years now there has been much debate around the benefits and possible harms of the PSA test for prostate cancer. It may come as a surprise to some that despite advances in medical technology there is still no consensus on using the PSA test
in men with no history of prostate cancer.

Early detection of prostate cancer is complex with many factors to consider, the following points emerged from a recent review conducted by Andrology Australia:

  • It is generally agreed that using the PSA test for mass population screening is not warranted.
  • Informed (or shared) decision-making should be supported, considering the harms and benefits of testing, and testing should not take place in uninformed men.
  • Men with a family history of prostate cancer may benefit from testing at a younger age than men at general (population) risk.
  • There is general agreement that initial PSA results should guide the interval for later testing.
  • Two recent studies from NSW1 and Victoria2 have looked at survival in
  • Men with less than about 10–15 years life expectancy should not have a PSA test.
  • Including a digital rectal examination with a PSA test is recommended by most of the organisations/agencies
    reviewed, but not all.
  • There is still no agreement on the age at which a PSA test should be offered but an age range of 55-69 is endorsed
    by several organisations.
  • There is no clear agreement on the PSA level required for a prostate biopsy.

The one thing that is clear is that more research is needed into better screening tests or risk factors, benefits and harms of early detection, and the effectiveness and side-effects of treatments.

So is there any good news? Well, yes.

Magnetic resonance imaging (MRI) has been around for many years, but it is only recently that two studies conducted by Australia researchers have shown that a new form of MRI, multi-parametric MRI (mpMRI), is becoming accurate enough to be considered as an alternative to PSA testing or prostate biopsy.

It is too early to go to your GP to request a mpMRI, but if you are aged 55 or over or if you have a family history of prostate cancer you should be talking to your GP about your testing options.

About Ian Murray

Ian is a registered acupuncturist and Chinese Herbal Medicine practitioner at Kenmore Centre for Health. This website contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such.
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